声学辐射力脉冲弹性成像与APRI和FIB-4识别慢性乙型肝炎患者

StephenW

Ann Hepatol. 2018 Aug 24;17(5):789-794. doi: 10.5604/01.3001.0012.3137.
Acoustic Radiation Force Impulse Elastography with APRI and FIB-4 to Identify Significant Liver Fibrosis in Chronic Hepatitis B Patients.
Tseng CH1, Chang CY2, Mo LR2, Lin JT3, Tai CM2, Perng DS2, Lin CW2, Hsu YC.
Author information

1
    Division of Gastroenterology and Hepatology, E-DA cancer hospital/I-Shou University, Kaohsiung, Taiwan.
2
    Division of Gastroenterology and Hepatology, E-DA hospital/I-Shou University, Kaohsiung, Taiwan.
3
    Division of Gastroenterology and Hepatology, Fu-Jen Catholic University Hospital, New Taipei, Taiwan.

Abstract
INTRODUCTION AND AIM:

In chronic hepatitis B (CHB) patients with equivocal indication for antiviral therapy, therapeutic decision currently depends on histopathology of the liver. We aimed to evaluate if acoustic radiation force impulse (ARFI) in conjunction with aspartate transaminase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) score could replace liver biopsy to indicate treatment for CHB.
MATERIAL AND METHODS:

We prospectively enrolled 101 clinically non-cirrhotic patients whose serum alanine aminotransferase was mildly elevated (1-2 folds above the upper normal limit) despite a high viral load (HBV DNA > 2,000 IU/mL). All participants underwent liver biopsy, and measurement of ARFI, APRI and FIB-4. The ability of the markers to distinguish fibrosis ≥ METAVIR F2 was evaluated.
RESULTS:

According to histopathology, liver fibrosis was METAVIR F0 in 2 (2.0%), F1 in 43 (42.6%), F2 in 34 (33.7%), F3 in 16 (15.8%), and F4 in 6 (5.9%) patients, and was correlated with ARFI (p = 0.0001), APRI (p = 0.012), and FIB-4 (p = 0.004). The six patients with cirrhosis were included for analysis, and received antiviral therapy. The C statistics of ARFI, APRI, and FIB-4 for fibrosis ≥ F2 were 0.70 (95% confidence interval [CI], 0.59-0.80), 0.62 (95% CI, 0.51-0.73), and 0.64 (0.53- 0.75), respectively. The cut-off values for 95% sensitivity and 95% specificity to identify significant fibrosis were 0.97 m/sec and 1.36 m/sec for ARFI, 0.36 and 1.0 for APRI, 0.63 and 2.22 for FIB-4, respectively. Using a combination of these 3 indices, 44 patients (43.6%) could be spared a liver biopsy procedure.
CONCLUSIONS:

A combination of ARFI, APRI, and FIB-4 may spare some CHB patients with equivocal indication for antiviral treatment a liver biopsy.
KEYWORDS:

Acoustic radiation force impulse; Antiviral treatment; Aspartate transaminase to platelet ratio index; Chronic hepatitis B; Fibrosis-4 score

PMID:
    30145564
DOI:
    10.5604/01.3001.0012.3137

StephenW

安·赫普托尔。 2018年8月24日; 17（5）：789-794。 doi：10.5604 / 01.3001.0012.3137。
声学辐射力脉冲弹性成像与APRI和FIB-4识别慢性乙型肝炎患者的显着肝纤维化。
Tseng CH1，Chang CY2，Mo LR2，Lin JT3，Tai CM2，Perng DS2，Lin CW2，Hsu YC。
作者信息

1
    台湾高雄市E-DA癌症医院/ I-Shou大学消化内科和肝病科。
2
    台湾高雄市E-DA医院/ I-Shou大学消化内科和肝病科。
3
    台湾新北市辅仁天主教大学医院消化内科和肝病科。

抽象
引言和目的：

在对抗病毒治疗具有可疑指征的慢性乙型肝炎（CHB）患者中，治疗决定目前取决于肝脏的组织病理学。我们的目的是评估声辐射力脉冲（ARFI）与天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化-4（FIB-4）评分相结合是否可取代肝活检以指示CHB治疗。
材料与方法：

我们前瞻性地招募了101名临床上非肝硬化患者，其血清丙氨酸氨基转移酶轻度升高（高于正常上限1-2倍），尽管病毒载量高（HBV DNA> 2,000 IU / mL）。所有参与者都进行了肝脏活组织检查，并测量了ARFI，APRI和FIB-4。评估了标志物区分纤维化≥METAVIRF2的能力。
结果：

根据组织病理学，肝纤维化为METAVIR F0 2（2.0％），F1为43（42.6％），F2为34（33.7％），F3为16（15.8％），F4为6（5.9％）患者，并且与ARFI（p = 0.0001），APRI（p = 0.012）和FIB-4（p = 0.004）相关。将6名肝硬化患者纳入分析，并接受抗病毒治疗。纤维化≥F2的ARFI，APRI和FIB-4的C统计量为0.70（95％置信区间[CI]，0.59-0.80），0.62（95％CI，0.51-0.73）和0.64（0.53-0.75） ， 分别。鉴定显着纤维化的95％灵敏度和95％特异性的临界值对于ARFI为0.97m / sec和1.36m / sec，对于APRI为0.36和1.0，对于FIB-4为0.63和2.22。使用这3个指标的组合，44名患者（43.6％）可以免于肝脏活组织检查程序。
结论：

ARFI，APRI和FIB-4的组合可以使一些CHB患者对肝活组织检查的抗病毒治疗具有可疑指示。
关键词：

声辐射力脉冲;抗病毒治疗;天冬氨酸转氨酶与血小板比值指数;慢性乙型肝炎;纤维化-4评分

结论：
    30145564
DOI：
    10.5604 / 01.3001.0012.3137